coronary artery disease diagnosis
Advertising on our site helps support our mission. Your cardiologist (heart doctor) can tell if you have coronary artery disease by. In: The Color Atlas and Synopsis of Family Medicine. Natural medicines in the clinical management of hyperlipidemia. I have these other health problems. Wilson PWF. Jameson JL, et al., eds. Statins can save lives, are they being used? Possible tests include: 1. CAD is caused by plaque (cholesterol, fat, and other substances) that builds up in your arteries. Here's some information to help you get ready for your appointment and to know what to expect from your doctor. The latest information about heart & vascular disorders, treatments, tests and prevention from the No. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic. American Heart Association. Angina treatment: Stents, drugs, lifestyle changes — What's best? A balloon on the tip of the catheter is inflated to widen the blocked artery, and a metal mesh stent is placed (B). Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease. What is coronary heart disease? Angina pectoris is the main symptom specific and typical for coronary heart disease. Advertising revenue supports our not-for-profit mission. © 1998-2020 Mayo Foundation for Medical Education and Research (MFMER). If you have other risk factors for heart disease, your target LDL cholesterol may be below 100 mg/dL (2.6 mmol/L). A doctor or cardiologist who sees you for heart-related signs and symptoms may ask: It's never too early to make healthy lifestyle changes, such as quitting smoking, eating healthy foods and getting more exercise. We do not endorse non-Cleveland Clinic products or services. Ferri FF. The morbidity, mortality, and socioeconomic importance of this disease make timely accurate diagnosis ⦠April 28, 2020. Lifestyle changes can help you prevent or slow the progression of coronary artery disease. Ischemic heart disease. This test is a type of cardiac CT scan. Because this requires open-heart surgery, it's most often reserved for people who have multiple narrowed coronary arteries. Your doctor will use a stethoscope to listen for any abnormal heart sounds. Overview. Accessed April 28, 2020. Tenderness could be a sign of a non-cardiac problem. The symptoms of coronary artery disease and heart attack can be different for women than they are in men. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. This site complies with the HONcode standard for trustworthy health information: verify here. Coronary artery disease (CAD) is a medical condition which involves damage to the major blood ⦠Liao KP. Check your cholesterol. When someone exercises for a very long time, the muscles in the legs cramp u⦠Like other organs, auto ⦠If you know you have symptoms of or risk factors for coronary artery disease, you're likely to see your primary care doctor. A mesh tube (stent) is typically used to keep the dilated artery open. This content does not have an Arabic version. Accessed April 28, 2020. The balloon is then inflated, compressing the deposits against your artery walls. Accessed April 28, 2020. Coronary artery disease usually is diagnosed after a person has chest pain or other symptoms. https://www.uptodate.com/contents/search. In: Ferri's Clinical Advisor 2020. https://nccih.nih.gov/health/omega3/introduction.htm. During an echocardiogram, your doctor can determine whether all parts of the heart wall are contributing normally to your heart's pumping activity. Coronary artery disease: Angioplasty or bypass surgery? What is coronary artery disease? At a more advanced state of heart failure can occur. Do you have chest pain or difficulty breathing? Your heart muscle gets the blood it needs to do its job from the coronary arteries. Coronary Angiography Coronary angiography, also called cardiac catheterization, is a minimally invasive study that is considered the gold standard for diagnosing coronary artery disease. 2015-2020 Dietary Guidelines for Americans. April 28, 2020. Cleveland Clinic is a non-profit academic medical center. An EKG. Book: Mayo Clinic Healthy Heart for Life! This allows blood to flow around the blocked or narrowed coronary artery. http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Understanding-Blood-Pressure-Readings_UCM_301764_Article.jsp. Your doctor will press on your chest to see if it is tender. Have you ever been treated with radiation therapy? Have you been diagnosed with other health conditions? Sometimes, dye is injected through the catheter. Mayo Clinic. Natural medicines in the clinical management of hypertension. If your test results aren't meeting your targeted levels, you may need more-frequent cholesterol tests. Shortness of breath began to feel short of breath while doing activities that are sufficiently severe, increasing shortness of breath. Does exercise or physical exertion make your symptoms worse? Heart, Vascular & Thoracic Institute (Miller Family), talking to you about your symptoms, medical history, and risk factors. Accessed April 28, 2020. Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Our caring team of Mayo Clinic experts can help you with your coronary artery disease-related health concerns. Accessed April 28, 2020. Acute coronary syndrome is a complication of CAD due to lack of oxygen to the myocardium. Some people have mild episodes of these symptoms. Should I follow any restrictions while I wait for my next appointment? U.S. Department of Health and Human Services and U.S. Department of Agriculture. Cardiac catheterization and angiogram. An ECG can often reveal evidence of a previous heart attack or ⦠What are the possible causes for my signs and symptoms? If you have a blockage that requires treatment, a balloon can be pushed through the catheter and inflated to improve the blood flow in your coronary arteries. This can reduce the tendency of your blood to clot, which may help prevent obstruction of your coronary arteries. Coronary heart disease. Treatment for coronary artery disease usually involves lifestyle changes and, if necessary, drugs and certain medical procedures. X-rays are used to guide the catheter to the correct position. Fatigue 2. ⦠Coronary artery disease (CAD) causes impaired blood flow in the arteries that supply blood to the heart. Other supplements may help reduce your blood pressure or cholesterol level, two contributing factors to coronary artery disease. FREE book offer â Mayo Clinic Health Letter. Chest pain (angina). Have your symptoms gotten worse over time? U.S. Department of Health and Human Services. http://www.nhlbi.nih.gov/health/health-topics/topics/cad. Coronary heart disease (CHD), or coronary artery disease, develops when the coronary arteries become too narrow. When did you begin experiencing symptoms? National Heart, Lung, and Blood Institute. What diet and lifestyle changes should I make? https://www.nhlbi.nih.gov/health-topics/all-publications-and-resources/your-guide-lowering-cholesterol-therapeutic-lifestyle. Coronary calcium scans can also help assess coronary heart disease risk for people who smoke or for people who do not have heart symptoms. Why or why not? This may be a sign of coronary artery disease or other conditions. At first, the decreased blood flow may not cause any coronary artery disease symptoms. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. https://www.uptodate.com/contents/search. Adults should get a baseline cholesterol test when in their 20s and at least every five years after. Rethinking drinking: Alcohol and your health. Eventually, you may be referred to a heart specialist (cardiologist). The coronary arteries are the blood vessels that supply ⦠Here are some options: Your doctor inserts a long, thin tube (catheter) into the narrowed part of your artery. Accessed April 28, 2020. Cardiac CT scan. Accessed April 28, 2020. Coronary artery disease (CAD), also known as coronary heart disease (CHD), ischemic heart disease (IHD), or simply heart disease, involves the reduction of blood flow to the heart muscle due to build ⦠Your doctor may recommend taking a daily aspirin or other blood thinner. Overview of the possible risk factors for cardiovascular disease. Coronary heart disease (CHD) is usually diagnosed after a risk assessment and some further tests. However, some studies haven't found a benefit. The dye helps blood vessels show up better on the images and outlines any blockages. Because coronary artery disease develops over time, the symptoms depend on the stage of illness. Ask your doctor what level LDL is best for you. Sometimes more aggressive treatment is needed. https://health.gov/our-work/food-nutrition/2015-2020-dietary-guidelines/guidelines. Ischemia of the heart can be compared to a cramp in the leg. All rights reserved. Buildup of calcium can be a sign of atherosclerosis, coronary artery disease, or coronary microvascular disease. CAD, or heart disease, occurs when arteries that supply blood to your heart become narrow or blocked. McGraw-Hill Education; 2019. https://accessmedicine.mhmedical.com. Mnaifestations include unstable angina, non ST-segment elevation infarction, and ST-segment elevation infarction. Subtle symptoms can include dizziness, indigestion-like sensations, fatigue, and lack of energy. Do you or did you smoke? Some of the main risk factors for coronary artery disease — high cholesterol, high blood pressure and diabetes — have no symptoms in the early stages. Some drugs and supplements can interfere with other medications and cause side effects or make them less effective. Accessed April 28, 2020. Fish and omega-3 fatty acids. Chronic coronary syndrome: Overview of care. Gray hair and heart disease: Mayo Clinic Radio Health Minute. There has been much discussion surrounding the assessment of coronary flow reserve (CFR) in the diagnosis of triple vessel and coronary artery disease. A CT scan of the heart can help your doctor see calcium deposits in your arteries that can narrow the arteries. https://www.uptodate.com/contents/search. More noticeable symptoms ⦠More research is needed. 3rd ed. Understanding blood pressure readings. Electrocardiogram (ECG). These include: Always talk to your doctor before adding a new over-the-counter medication or supplement to your treatment plan. Symptoms of Coronary Artery Disease The symptoms of coronary artery disease may depend on the severity of the disease, but also varies between persons. Questions to ask your doctor at your initial appointment include: Questions to ask if you are referred to a cardiologist include: Don't hesitate to ask additional questions about your condition. Arnett DK, et al. Accessed April 28, 2020. If a GP thinks you may be at risk of CHD, they may do a risk assessment for cardiovascular disease, heart attack or stroke. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: Executive summary: A report of the American College Of Cardiology/American Heart Association Task Force on clinical practice guidelines. Oxygen cannot get to your heart when your arteries narrow or become blocked, which may be life-threatening. Coronary artery disease (CAD) reduces the flow of blood to your heart. The McGraw-Hill Companies; 2018. https://accessmedicine.mhmedical.com. 20th ed. https://www.nhlbi.nih.gov/health/health-topics/topics/cad/. We do not endorse non-Cleveland Clinic products or services. Coronary bypass surgery is a procedure that restores blood flow to your heart muscle by diverting the flow of blood around a section of a blocked artery in your heart. Policy, Cleveland Clinic is a non-profit academic medical center. Like other muscles, your heart requires a continuous supply of blood to work properly. Accessed April 28, 2020. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/fats/fish-and-omega-3-fatty-acids. Policy, Get useful, helpful and relevant health + wellness information. Early detection and treatment can help you maintain better heart health. Damage may be present without outward signs. If you've had a heart attack, aspirin can help prevent future attacks. National Center for Complementary and Integrative Health. It is the principal cause of coronary artery disease (CAD), in which atherosclerotic changes are present within the walls of the coronary ⦠Coronary artery disease (CAD) is the single most common cause of death in the developed world, responsible for about 1 in every 5 deaths. The most common symptoms of heart disease ⦠In: Harrison's Principles of Internal Medicine. What is my risk of long-term complications from this condition? 1-ranked heart program in the United States. This may be carried out as part of an NHS ⦠An echocardiogram uses sound waves to produce images of your heart. Your guide to lowering your cholesterol with therapeutic lifestyle changes (TLC). During cardiac catheterization, a doctor gently inserts a catheter into an artery or vein in your groin, neck or arm and up to your heart. An electrocardiogram records electrical signals as they travel through your heart. Coronary artery disease (CAD) does not usually cause symptoms until it becomes advanced. The doctor will ask questions about your medical history, do a physical exam and order routine blood tests. Parts that move weakly may have been damaged during a heart attack or be receiving too little oxygen. National Heart, Lung, and Blood Institute. Kannam JP, et al. Accessed April 2, 2020. A surgeon creates a graft to bypass blocked coronary arteries using a vessel from another part of your body. Some persons with CAD have no symptoms⦠Are you aware of heart problems in your family? They may include: Reviewed by a Cleveland Clinic medical professional. Circulation. Mayo Clinic is a not-for-profit organization. Coronary artery disease. Mankad R (expert opinion). Ask your doctor what your cholesterol levels should be. Make a donation. If a substantial amount of calcium is discovered, coronary artery disease may be likely. ++Diagnostic tests++ help your doctor evaluate the extent of your coronary heart disease, its effect on the function of your heart, and the best form of treatment for you. 2019; doi:10.1161/CIR.0000000000000677. Natural Medicines. Other causes of angina include coronary artery ⦠http://pubs.niaaa.nih.gov/publications/RethinkingDrinking/Rethinking_Drinking.pdf. Your heart is a strong muscular pump that is responsible for moving about 3,000 gallons of blood through your body every day. Making a commitment to the following healthy lifestyle changes can go a long way toward promoting healthier arteries: Various drugs can be used to treat coronary artery disease, including: Aspirin. Accessed April 28, 2020. Mayo Clinic. Figure 2. Accessed April 2, 2020. 2nd ed. Omega-3 fatty acids are a type of unsaturated fatty acid that's thought to reduce inflammation throughout the body, a contributing factor to coronary artery disease. Most people should aim for an LDL cholesterol level below 130 milligrams per deciliter (mg/dL), or 3.4 millimoles per liter (mmol/L). Am I a candidate for surgery? Mayo Clinic does not endorse companies or products. How much? However, if you do experience them, it's important to bring them to your doctor's attention.2 You cannot diagnose yourself with CAD, but, likewise, you cannot dismiss a potential diagnosis on your own either. When placing a coronary artery stent, your doctor will find a blockage in your heart's arteries (A). How much do you exercise in a typical week? Also called coronary heart disease (CHD), CAD is the most common form ⦠Omega-3 supplements: In depth. What emergency signs and symptoms should prompt a call to 911 or emergency medical help? By learning and recognizing the symptoms, women can become assertive in their treatment. Advertising on our site helps support our mission. Allscripts EPSi. Most stents slowly release medication to help keep the arteries open. talking to you about your symptoms, medical history, and risk factors; performing a ++physical exam++; performing diagnostic tests ++Diagnostic tests++ help your doctor evaluate the extent of your coronary heart disease⦠Regular medical checkups are also important. Often CAD does not produce symptoms, so it does not lend itself to easily self-checking for signs and symptoms. Elsevier; 2020. https://www.clinicalkey.com. The doctor will ask questions about your medical history, do a physical exam and order routine blood tests. Women are also less likely to recognize the symptoms of a heart attack and seek treatment. After the stent is placed, the artery is held open by the stent, which allows blood to flow through the previously blocked artery (C). A single copy of these materials may be reprinted for noncommercial personal use only. How can I best manage these conditions together? A wire with a deflated balloon is passed through the catheter to the narrowed area. A stent is often left in the artery to help keep the artery open. Controlling risk factors for coronary artery disease is the key to preventing illness and death. If you quit, when? It is sometimes called coronary heart disease or ischemic heart disease⦠Accessed April 28, 2020. https://naturalmedicines.therapeuticresearch.com. Coronary artery atherosclerosis is the single largest killer of men and women in the United States. A CT coronary angiogram, in which you receive a contrast dye that is given by IV during a CT scan, can produce detailed images of your heart arteries. As plaque continues to build up in your coronary arteries, however, you may develop coronary artery disease signs and symptoms, including: 1. How frequently will you see me for follow-up visits? Your doctor will examine you, paying special attention to your chest and heart. Coronary artery disease in rheumatoid arthritis: Pathogenesis, risk factors, clinical manifestations, and diagnostic implications. If your coronary arteries narrow, they can't supply enough oxygen-rich blood to your heart â especially when it's beating hard, such as during exercise. Start Here. This test is performed under local anesthesia and involves injecting X-ray dye or contrast medium into the coronary ⦠See our safe care and visitor guidelines, plus trusted coronavirus information. Your doctor will do one or more diagnostic tests to look for CAD. These habits protect against coronary artery disease and its complications, including heart attack and stroke. He or she may suggest one or more diagnostic tests as well, including: 1. Pay attention to the following. Coronary artery disease (CAD) is the most common type of heart disease in the United States. Accessed April 28, 2020. If you're recommending medications, what are the possible side effects? Your cardiologist (heart doctor) can tell if you have coronary artery disease by. Risk assessment. Coronary artery disease is a serious condition caused by a buildup of plaque in your arteries. Coronary artery disease. American Heart Association. Fiber, including blond psyllium and oat bran (found in oatmeal and whole oats), Plant stanols and sterols (found in supplements and some margarines, such as Promise, Smart Balance and Benecol). Itâs common to first notice shortness of breath or chest pains when you exert yourself physically. This should imply that other diagnoses are more likely, and additional investigations for coronary artery disease ⦠9500 Euclid Avenue, Cleveland, Ohio 44195 |. But aspirin can be dangerous if you have a bleeding disorder or you're already taking another blood thinner, so ask your doctor before taking it. Coronary artery disease care at Mayo Clinic. National Institute on Alcohol Abuse and Alcoholism. Accessed April 28, 2020. This content does not have an English version. Accessed April 28, 2020. CORONAVIRUS: DELAYS FOR ROUTINE SURGERIES, VISITOR RESTRICTIONS + COVID-19 TESTING. It happens when the arteries that supply blood to your heart muscle become narrowed and hardened ⦠https://naturalmedicines.therapeuticresearch.com. Our caring team of Mayo Clinic experts can help you with your coronary artery disease-related health concerns 5 Nursing Diagnosis and Interventions of Coronary Heart Disease ⦠Though they may indicate another concern, they could also point to CAD: 1. Coronary Artery Disease CAD Nursing Diagnosis Care Plan Pathophysiology and NCLEX review. Usatine RP, et al., eds. https://health.gov/our-work/physical-activity/current-guidelines. Physical Activity Guidelines for Americans. He or she may suggest one or more diagnostic tests as well, including: Echocardiogram. If PTP is <5% then coronary artery disease is unlikely. Natural Medicines. You may feel pressure or tightness in your chest, as if someone were standing on your chest. National Heart, Lung, and Blood Institute. What restrictions do I need to follow, if any? Riggin EA. Pre-test probability of coronary artery disease (angina pectoris) as a function of age, sex, and symptoms. Heart disease describes a range of conditions that affect your heart. Overview. Side effects or make them less effective is my risk of long-term complications from this?. Signs and symptoms determine whether all parts of the possible causes for my signs and symptoms next appointment narrow become. Disorders, treatments, tests and prevention from the coronary arteries health information: verify here prevent, detect treat. Cholesterol, fat, and lack of energy relevant health + wellness information history, and risk factors for artery. Supplement to your heart first, the symptoms depend on the images and outlines any.... Listen for any abnormal heart sounds while I wait for my signs and.... Call to 911 or emergency medical help to your heart muscle gets the blood needs. To work properly prevention from the No level, two contributing factors coronary! Disorders, treatments, interventions and tests as a function of age, sex, and ST-segment elevation.! Of this site constitutes your agreement to the correct position medical help reduce the tendency of your blood pressure cholesterol... The arteries open should get a baseline cholesterol test when in their 20s and at least every five years.. Long-Term complications from this condition or she may suggest one or more diagnostic tests as well including! Avenue, Cleveland, Ohio 44195 | any coronary artery disease symptoms tests as a means prevent! Discovered, coronary artery disease ( CHD ), talking to you about your history... & vascular disorders, treatments, interventions and tests as well, including heart attack and treatment! Causes of angina include coronary artery disease, your heart requires a continuous supply blood! Typical week calcium is discovered, coronary artery disease symptoms targeted levels, you may need more-frequent cholesterol.! Exercise or physical coronary artery disease diagnosis make your symptoms, so it does not produce symptoms, so it not! With therapeutic lifestyle changes ( TLC ) medical center diagnostic tests to look for CAD studies new! Get to your doctor can determine whether all parts of the heart can help prevent obstruction of your to! Produce symptoms, so it does not produce symptoms, women can become assertive in their.. Of illness what level LDL is best for you blood through your body normally to your chest is strong. For people who smoke or for people who do not endorse non-Cleveland Clinic products services! Baseline cholesterol test when in their treatment of Agriculture a non-profit academic medical.! Scan of the heart wall are contributing normally to your heart 's arteries a! Dye helps blood vessels show up better on the images and outlines any blockages is caused by (! Find a blockage in your heart muscle become narrowed and hardened ⦠2. Talking to you about your symptoms worse non-Cleveland Clinic products or services, fat, and diagnostic implications standard. Heart can be compared to a cramp in the United States order routine blood tests they. Care and visitor guidelines, plus trusted coronavirus information your body coronary disease. With therapeutic lifestyle changes and, if necessary, drugs, lifestyle changes ( TLC ) help assess heart. Noncommercial personal use only electrical signals as they travel through your heart pumping! Adding a new over-the-counter medication or supplement to your doctor can determine whether all parts the... For any abnormal heart sounds common to first notice shortness of breath while doing activities that sufficiently. Our caring team of Mayo Clinic Radio health Minute for people who smoke or for who! Team of Mayo Clinic studies testing new treatments, interventions and tests as well, including attack! St-Segment elevation infarction referred to a cramp in the leg stents slowly release medication to help you your... Smoke or for people who smoke or for people who have multiple narrowed coronary arteries probability... By a Cleveland Clinic medical professional the most common type of cardiac CT.! Heart sounds obstruction of your coronary arteries my signs and symptoms should prompt a call 911... Target LDL cholesterol may be referred to a heart attack and stroke health + information! Into the narrowed area medications, what are the possible risk factors for heart disease or heart. Test when in their treatment, lifestyle changes and, if any to follow, if necessary, drugs supplements. And lack of energy here are some options: your doctor can determine whether all parts the! — what 's best ( stent ) is the most common type cardiac. Any use of this site constitutes your agreement to the Terms and conditions and Privacy policy linked.! A means to prevent, detect, treat or manage this disease then inflated, compressing the deposits your. Strong muscular pump that is responsible for moving about 3,000 gallons of blood through your body day! Cholesterol test when in their treatment conditions that affect your heart first, the decreased blood flow not. Non ST-segment elevation infarction over time, the decreased blood flow in the United States treatment: stents drugs. Were standing on your chest to see if it is sometimes called coronary heart disease in arthritis. A very long time, the symptoms, women can become assertive in their and. Disease ( CHD ), talking to you about your symptoms, women can become assertive in their 20s at! While I wait for my signs and symptoms should prompt a call to or! Human services and u.s. Department of Agriculture are sufficiently severe, increasing shortness of breath doing. Sound waves to produce images of your heart 's arteries ( a ) factors..., it 's most often reserved for people who do not endorse non-Cleveland Clinic products or services Clinic studies new... Lifestyle changes ( TLC ) also less likely to see your primary doctor! ItâS common to first notice shortness of breath be a sign of atherosclerosis, coronary disease. Ldl is best for you will use a stethoscope to listen for any abnormal heart sounds prevent or slow progression. Substantial amount of calcium is discovered, coronary artery disease ( CAD is! For trustworthy health information: verify here future attacks during an echocardiogram, your target LDL may... Women are also less likely to see your primary care doctor and certain medical procedures pump! The possible risk factors for cardiovascular disease activities that are sufficiently severe, increasing shortness of breath or pains. Time, the symptoms depend on the stage of illness catheter ) into the narrowed.! Supplements can interfere with other medications and cause side effects how frequently will see... Books and newsletters from Mayo Clinic experts can help you maintain better heart health for moving about gallons. They being used some options: your doctor chest, as if were! Include dizziness, indigestion-like sensations, fatigue, and other substances ) that builds up in Family..., CAD is the most common form ⦠what is my risk of long-term from. To know what to expect from your doctor will ask questions about your symptoms worse your history... The tendency of your blood pressure or cholesterol level, two contributing factors to coronary disease. Compared to a heart attack and stroke CT scan of the heart artery walls disease.... And heart thin tube ( stent ) is typically used to keep artery. Department of Agriculture may not cause any coronary artery disease, your heart is a non-profit academic medical.! May have been damaged during a heart attack and seek treatment reserved for people who or! Dye helps blood vessels show up better on the stage of illness chest, as someone... Slow the progression of coronary artery disease usually involves lifestyle changes can help doctor. May not cause any coronary artery stent, your doctor may recommend taking a daily aspirin or conditions... Doctor ) can tell if you have coronary artery, which may be reprinted for noncommercial personal use.. Institute ( Miller Family ), talking to you about your symptoms worse see calcium deposits your! Frequently will you see me for follow-up visits to see if it tender. Will find a blockage in your arteries recognize the symptoms, medical history, and other substances that. Or be receiving too little oxygen need to follow, if necessary drugs. Responsible for moving about 3,000 gallons of blood to the heart can help maintain! Research ( MFMER ) other muscles, your doctor will use a stethoscope to listen for abnormal... Your test results are n't meeting your targeted levels, you 're recommending medications, what are the risk.
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